Use of anesthetics, surgical technique, and postoperative management
MICS was performed via a 5–6-cm lateral right thoracotomy. The surgical approaches used were via the third intercostal space in aortic valve surgery and via the fourth intercostal space in mitral valve surgery.
In case of retrograde perfusion, we cannulated the femoral artery via a small skin incision in the inguinal region with the direct cannulation technique. The femoral vein was cannulated with a venous cannula, and transesophageal echocardiography was performed to assess the guide wire and cannula in the bicaval view.
Cross-clamping was performed directly via the incision. In both the aortic and mitral valves, antegrade cardioplegia was delivered via a root cannula into the aortic root.
The removal of air was performed via a vent placed in the aortic root and left ventricle in aortic valve surgery and via a vent in the aortic root in mitral valve surgery.
In our hospital, CPB is initiated with a perfusion index of 2.6 L/min × m2 and conducted with a systemic temperature of 32°C.
The procedures were performed under direct visualization with thoracoscopic guidance. CO2 insufflation into the right thoracic cavity was performed with a flow rate of 5 L/min during the procedure.